Barrett’s Esophagus


WHAT IS BARRETT’S ESOPHAGUS?

Barrett's esophagus is a GI condition that develops when the flat, pink lining of the esophagus is damaged due to acid reflux, causing the lining to thicken and become red in response. Because the esophagus connects the mouth to the stomach and plays a major role in digestion, damage can result in unpleasant GI symptoms.

When the lower esophageal sphincter, the valve between the esophagus and stomach, does not function properly, acid can rise back up into the esophagus. This condition is commonly called GERD, short for gastroesophageal reflux disease. GERD sufferers often experience heartburn or regurgitation, but in more serious cases, GERD can trigger a change in lower esophageal cells – called Barrett’s esophagus.

Barrett's esophagus is linked to an increased risk of esophageal cancer. While the risk remains low, we recommend regular checkups to monitor the condition, with imaging and biopsies performed to check for precancerous cells. If discovered in time, these cells can be treated to prevent esophageal cancer.

Read on to learn more, then schedule your consultation at Charleston GI. Our board-certified gastroenterologists are specially trained to treat a wide variety of conditions, including those detailed below.

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CAUSE

The exact cause of Barrett's esophagus remains unknown. While many sufferers have chronic GERD, others have no reflux symptoms at all. This condition may be referred to as “silent reflux."

Regardless of whether reflux symptoms are experienced, stomach acid and chemicals wash back into the esophagus, causing damage to esophageal tissue. The presence of acid also triggers changes in the lining of the esophagus, causing Barrett's esophagus.

RISK FACTORS 

These factors are associated with an increased risk in developing Barrett’s esophagus:

  • Family history.
  • Being male.
  • Being white.
  • Being over 50 years old.
  • Chronic heartburn and acid reflux.
  • Being a smoker (past or present).
  • Being overweight.

SYMPTOMS

The development of Barrett's esophagus is commonly attributed to long-standing GERD, a GI condition with these symptoms:

  • Frequent heartburn. 
  • Regurgitation 
  • Trouble swallowing food.
  • Chest pain (less common).

Keep in mind that about half of the people diagnosed with Barrett's esophagus have few, if any, GERD symptoms. That’s why it is important to consult a Charleston GI doctor near you.

COMPLICATIONS

People with Barrett's esophagus face an elevated risk of esophageal cancer. But fortunately, the risk is still low, even in those with precancerous changes in their esophagus cells. In most instances, patients with Barrett's esophagus never develop esophageal cancer.

WHEN TO SEE A DOCTOR

If you have been experiencing frequent heartburn, regurgitation, and acid reflux for more than five years, it is important to ask your gastroenterologist about your risk of Barrett's esophagus.

Consult your physician right away if any of the following occur:

  • You experience chest pain, potentially indicating a heart attack. 
  • You have difficulty swallowing.
  • You vomit red blood or blood that resembles coffee grounds.
  • You pass black, tar-like, or bloody stools.
  • You lose weight unintentionally.

DIAGNOSTIC TEST 

An upper endoscopy is the only method used to confirm a Barrett’s esophagus diagnosis. A small tube with a light and camera on the end (endoscope) will be inserted through the mouth to get a better view inside the throat. Because it’s impossible to conclusively diagnose by appearance alone, a small tissue sample (biopsy) will be taken to ensure accuracy.

TREATMENT

Treatment depends on the extent of abnormal esophageal cell growth and severity of symptoms. If no dysplasia is present, your GI specialist may recommend:

  • Periodic endoscopy to monitor esophageal cells (follow-up after one year, then every three to five if no changes are noted).
  • Medication and lifestyle changes to relieve GERD symptoms. 
  • Surgery or endoscopy procedures to correct a hiatal hernia or tighten the lower esophageal sphincter. 

If low-grade dysplasia is detected, meaning that some abnormal cells are present, your gastroenterologist will likely request an upper endoscopy and routine follow-up every six months to a year. Ablation therapy is another common treatment for some patients.

High-grade dysplasia indicates a significant change in the esophageal lining. In these cases, cancer is more likely. That’s why more frequent upper endoscopies are needed to closely monitor abnormal cells. Radiofrequency ablation is the most common treatment, used to burn off abnormal tissue using radio waves. Cryotherapy, the use of liquid nitrogen to freeze diseased parts of the esophagus lining, may also be an option. Endoscopic mucosal resection, the removal of precancerous spots, or surgery may also be recommended for patients with high-grade dysplasia.

FOODS TO AVOID WITH BARRETT’S ESOPHAGUS

A high-sugar, high-carb diet may also cause excess weight gain and obesity. Avoiding or limiting foods with added sugars and simple carbohydrates can help maintain a healthy weight. 

Stay away from the following:

  • Table sugar, or sucrose
  • Glucose, dextrose, and maltose
  • Corn syrup and high fructose corn syrup
  • White breads, flour, pasta, and rice
  • Baked goods (cookies, cakes, etc.)
  • Boxed cereals and breakfast bars
  • Potato chips and crackers
  • Sugary drinks and fruit juices
  • Soda
  • Ice cream
  • Flavored coffee drinks

Our GI physicians also recommend avoiding the following common foods to prevent reflux:

  • Alcohol
  • Coffee
  • Tea
  • Milk and dairy products
  • Chocolate
  • Peppermint
  • Tomatoes, tomato sauce, and ketchup
  • Fried foods (fries, battered fish, onion rings, etc.)
  • Red meat (steak, burgers, etc.)
  • Processed meats (hot dogs, etc.)
  • Mustard
  • Spicy foods/condiments (jalapeños, curry, hot sauce, etc.)
  • Peppermint
  • Carbonated beverages

Note: If the foods listed above aren’t triggering heartburn or acid reflux symptoms, there’s no need to avoid them. But be sure to consume smaller, more frequent meals instead of larger ones. 

FOODS TO EAT TO MANAGE BARRETT’S ESOPHAGUS

These foods can help alleviate symptoms, so add them to your diet!

  • Fruits and vegetables (fresh, frozen, or dried)
  • Whole-grain breads and pasta
  • Brown rice
  • Beans
  • Lentils
  • Oats
  • Couscous
  • Quinoa
  • Fresh and dried herbs

Note: Consuming a fiber-rich diet promotes overall health. In fact, medical research reveals that it may also help prevent Barrett’s esophagus from worsening and lower your risk of esophageal cancer.

PREVENTION

These lifestyle and diet changes may help prevent or reverse Barrett’s esophagus while minimizing the risk of cancer:

  • Maintain a healthy weight.
  • Quit smoking.
  • Limit alcohol consumption.
  • Consume smaller meals.
  • Avoid late-night snacking or eating a few hours before bedtime.
  • Sleep with your head slightly elevated.

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FREQUENTLY ASKED QUESTIONS


Is Barrett's esophagus serious?

People with Barrett's esophagus face an increased risk of esophageal cancer, although it remains low. Fortunately, most people with Barrett's esophagus will never develop esophageal cancer.

Is Barrett's esophagus always cancerous?

No, Barrett's esophagus is considered a precancerous condition with a higher esophageal cancer risk. While only a small percentage of patients develop esophageal cancer, routine appointments are recommended to monitor the condition.

How long does it take for Barrett's esophagus to turn to cancer?

According to the National Library of Medicine, research reveals that the incubation period from Barrett’s esophagus to invasive cancer is typically more than 30 years.

How quickly does Barrett's esophagus grow?

Barrett's esophagus can progress about 0.33% per year. While only a small percentage of patients with Barrett's esophagus eventually develop esophageal cancer, it is important to monitor the condition closely.

How common is Barrett’s esophagus?

Barrett’s esophagus doesn’t produce symptoms on its own and is often only diagnosed when accompanied by GERD symptoms or when a patient develops esophageal cancer. That’s why it is difficult to determine how common it is. That said, medical experts estimate that only about 1% of patients have Barrett’s esophagus.

Who gets Barrett's esophagus?

Roughly 30 million people in North America suffer from GERD. In fact, it’s the most common chronic gastrointestinal disease. About 5% of patients with chronic GERD eventually develop Barrett's esophagus, making it much less common. Barrett’s esophagus develops more frequently in men than women, and more often affects Caucasian Americans than African Americans. The average age at diagnosis is 55 years.

Can you fix Barrett's esophagus?

No, there is no known cure for Barrett esophagus. Medication to reduce stomach acid and surgery (fundoplication) may be used to treat the condition. Because Barrett esophagus tends to recur in many patients, continued monitoring is necessary.

What is the life expectancy of someone with Barrett's esophagus?

The average life expectancy following diagnosis is 22 years – about the same as people without the GI condition. In most cases, there is another cause for fatality before Barrett’s esophagus turns into cancer. The lifetime risk of needing intervention for high-grade dysplasia or esophageal adenocarcinoma is between one in five and one in six patients.

What food should I not eat with Barrett’s esophagus?

Avoiding trigger foods, like chocolate, coffee, fried foods, peppermint, spicy foods, and carbonated beverages, can help alleviate symptoms. These foods boost acid levels in the stomach, triggering acid reflux symptoms. Your Charleston GI specialist may also recommend eating multiple smaller, more frequent meals as opposed to a few large ones.

What is the best diet for Barrett’s esophagus?

There isn’t a specific diet for Barrett’s esophagus, but if you suffer from GERD symptoms or heartburn, consider the following:

  • Avoid eating large meals.
  • Eat dinner at least three hours before bedtime.
  • Limit “trigger” foods like fried or fatty foods, chocolate, soda/carbonated drinks, and tomato sauce.

How can I prevent Barrett’s esophagus?

The best way to keep the lining of your esophagus healthy is to address heartburn or GERD symptoms when they arise. Research shows that untreated heartburn raises the risk of esophageal adenocarcinoma by 64 times. Here at Charleston GI, we believe that there’s no reason to suffer in silence. Schedule an appointment today to get relief from heartburn and GERD symptoms! We also recommend maintaining an appropriate weight, eating a healthy diet, avoiding alcohol consumption, and quitting smoking.

 

Source: National Institute of Diabetes & Digestive & Kidney Disease, American College of Gastroenterology & Cancer Research UK.


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